Review: Manufacturing Depression

How did it become common, if not mandatory, to think of our unhappiness as a disease? Manufacturing Depression tells the story of how advertising, pharmaceutical companies, and psychiatrists packaged unhappiness as a medical disease to be treated with antidepressants. If you want to understand how thirty million Americans came to take antidepressants at an annual cost of 10 billion dollars, this is the book for you.

MD mixes together personal memoir, case histories (Greenberg’s a practicing therapist), intellectual and business history, and guerilla journalism (he shows up as a mischievous patient in a clinical trial).

WHY SHOULD YOU READ IT?

Greenberg’s attack on the disease model is blistering, rambling and often funny.

With its interlocking narratives, it almost like you get 4 books for the price of one.

Historical case. The disease model was not foreordained or inevitable, but represents the coming together of big pharma and the cultural needs of the late 20th century. Greenberg delights in the irony that discredited treatments in the early 20th century such as insulin coma therapy and lobotomy set the stage for the magic pharmaceutical bullets.

Science case. Greenberg hammers home the differences between depression and bona fide diseases like cancer, diabetes, or flu. Unlike the latter, there remains no reliable biological marker of depression, or a validated theory of the biology that produces its symptoms. He covers the sad history of failed attempts to establish a biological basis of depression, from black bile to serotonin.

Clinical case. Greenberg points out that medications don't work well enough to be considered magic bullets. For example, the antidepressants beat placebo in only about half of clinical trials.

Humanist case. Greenberg objects to DSM's one-size-fits-all checklist - how the diagnoses rendered with this system stunt the experience and expression of psychological suffering. Where is the place for experience in the biomedical model that treats consciousness as "merely the steam rising offthe amino-acid-rich neurochemical soup that roils in dumb silence in your head?" As a practicing psychotherapist, he objects to how the disease model preempts the potentially redemptive power of self-exploration. He worries that if we call our misery a disease, we won't bother to try to fashion our past and present troubles into a coherent narrative. He worries that calling pessimism the symptom of an illness leads us to turn over our discontents to the medical industry and to surrender perhaps the most important portion of our autonomy, especially if our feelings of pessimism are"an ally at a time of crisis?"

ANY NEGATIVES?

MD is entertaining but it's not light reading. It's a real intellectual history. The story jumps around from germ theory, the transformation of German synthetic dye companies into pharmaceutical industry titans, and the numerous turf wars between psychiatrists, psychologists, and neurologists who fight about what is mental illness and who gets to diagnose and treat it. Some readers might find the range of topics to be dazzling. Other readers might find this approach to be a bit dizzying.

Greenberg’s book is more about demolishing an idea than creating one. It leaves unresolved a big question: If depression isn't a disease, then what is it?

OVERALL

One of the most thoughtful books on depression ever written. Mind expanding.

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